Internships in Puerto Escondido, Mexico

My arrival in Oaxaca State, MX was unremarkable, except for the fact that I failed to buy a ticket all the way into Puerto Escondido (Puerto). As a result, I had to pay for a van ride from Oaxaca city to Puerto. There was a couple there to meet and drive me to the hostel from which I rented an overnight room. As we drove, I saw crowds of young people congregating in the doorways of several buildings, but I did not make any connection as to why. I simply thought, “It’s Friday night and the young people are having a great time; much like those in the states.” Dr. Moira Rogers met me at the hostel and told me that the other students wanted to get an early start (7am) to Puerto and that I needed to be ready to leave the hostel by 6:40. Then she bid me a good night’s rest. At 6:30 am, Dr. Rogers knocked on my door and asked if I were awake. I was not because my flight to Oaxaca really was exhausting, a good 10-12 hours. I rushed to get ready then she and I walked to the meeting location. As we walked, I noticed that the different buildings were brightly colored with yellows, oranges, greens and blues. The homes/ hostels were a beautiful mix of stucco and brick and some of the doors had painted ghouls on them. That’s when it hit me that those groups of young people were celebrating “el Día de Muertos (The day of the dead.)” Like Halloween, people sometimes get dressed up, or will wear makeup to make them look like skeletons. But unlike Halloween, the celebration is more a veneration of one’s ancestors. It was interesting to see what my high school Spanish class taught me. And the depictions that I could remember came rushing back to me as Dr. Rogers and I made our way toward the pre-arranged meeting spot. The city was a wonderful mix of old-world charm and new world technology. The hostels were simple, yet functional but there were a few creature comforts, like one electrical outlet so I could charge my phone. No, seriously. When we arrived at the meeting place, there was no one there, and so we waited. I knew not to get upset or even a little irked because the concept of time is different in Mexico. Basically, everyone in the world knows that time is a human made concept that helps us to make appointments or track months and years. My travel training warned me of the cultural shift I would have to make in that, time was not under human control, so while people respected it, it’s not a huge deal if one was a little late. So, when there was no one there to meet us, Dr. Rogers and I simply chatted. As the time passed 7:30, in the back of my mind I kept hearing, “THESE are my people! I am finally HOME!” At about 7:45 am, the vans arrived, and I took more than the recommended amount of anti-nausea pills because the ride was going to be 6-7 hours, and y’all know that my chemotactic trigger center (the area of the brain that triggers vomiting, named thus because it was 1st identified in cancer patients who experienced vomiting after receiving chemo), otherwise known as Homey the Clown, don’t play that. I get motion sick with even a little jostling, so I prepared myself accordingly. The fact that the van was a Mercedes, helped to quell my worries, but what did I know? As we started the trip, everything was going well, and I felt no discomfort at all. As a matter of fact, I fell asleep and did not awaken until our first stop. Everyone was talking about the motion sickness they were experiencing and even a few of the students had Dramamine© with them, which they were all too happy to share (for the good of the community). I had my own anti-nausea medication and loaded up on that, pleasantly surprised that, so far, the ride up the mountain was not so bad. Our first stop was at a little place that served breakfast and coffee. Across from that, was “el baño” for those who needed to use the bathroom. Unbeknownst to me and several of my comrades, it was a pay bathroom with a tall-as-human turnstile. Even though it was not a lot in terms of US dollars, I still had an attitude that my pee was only worth 3 pesos. Unfortunately, I was not informed about the toilets themselves, so I wasted my 3 pesos because there were no toilet seats on the toilet (Yes, that means that I refused to use the toilets and put enormous amounts of pressure on my bladder and whatever nerve controls my bladder’s sphincter). The view from the little cafe was breathtaking. In almost every direction there were vast and verdant mountains with magnificent trees that hid the animals that made wild sounds we heard. The clouds were striking because of the way they blanketed the peaks and the fact that we were already up the mountain made me feel encouraged. After eating, we all loaded into our vans and began the next leg of the trip. Everyone was strategically passing Dramamine© around and I took that as my cue to take some more of my generic brand. As we continued our way up the mountains, life was fine, until we started down the mountain range, when one of my fellow travelers took ill into a plastic shopping bag. The bus driver pulled over and the young traveler quickly left the van. However, she and her bag went right past my nose and the smell made my chemotactic trigger center…begin to trigger. It was all I could do to keep from throwing up as well, but I had to recall all of my meditation techniques, like breathing deeply. To divert myself, I piled in some more of my generic anti-nausea medication, and that seemed to do the trick, constipation be damned. It turns out that the mountains that separate Oaxaca City and Puerto are called the Sierra del Sur, and our descent was jammed pack with non-stop hairpin turns: I’m not sure y’all read that with the gasp and horrified looks you were supposed to have… We were descending a mountain with HAIR. PIN. TURNS. every 30-50 feet for at least a few hours. Luckily, my anti-nausea medication from earlier, while it did not alleviate the headache portion of the motion sickness, did prevent me from vomiting. But only because, previously, I had a nominal meal. When we finally arrived in Puerto, I don’t think I had ever been happier to see level ground in my life! My contact, Soledad, drove me to the home of my host family, introduced us and then left. My host family is Mama Luz and Papa Juan, their daughter, Linnett and her son, Kennith. And they all greeted me in Spanish. I followed Mama Luz upstairs and was introduced to my room, given keys to the house and the password to the Wi-Fi. I was a little shell-shocked because I was thinking that I would be eased into the expectation of speaking Spanish. But no. I had to make the best of it, so I pretended to understand more than I did. Haha, not really (but yeah!) It turned out that Linnett speaks English, so I was ok although I often had to say, “Repitas, por favor?” Be that as it may, the best part of my introduction was…LUNCH! I was expecting a wonderful Mexican meal with all the fixins, including mole’, frijoles, carne, cheese, etc. What I got was a light meal of carne con mole’ and a dinner roll. Welp, the went my first culturally insensitive expectation! Their home is white stucco with red trim and is large. One needs keys to enter through the exterior gate which opens into a large atrium. Directly to the left is a section of the house that contains two apartments. The one on the bottom houses a single mom and her toddler son, Mati (Matty). Above that is an apartment that houses two male architect students. If one continues to walk straight, Mama Luz and Papa Juan’s house opens into a large room that doubles as a dining/family room and study area. To the left are, from front to rear, a master bedroom with private bath, a hall with a half bath, another bedroom with a private bath, and then ahead is the kitchenette with a rear entry to an open area, where they keep the dog. The kitchenette has a small island with a small 4-burner gas stove with a small amount of counter space. Across from it and at the rear of the house is a small sink with cabinets to the right and a refrigerator and cabinetry to the left. Above all of that is my room, which requires that I climb a winding stair case, but at the top is my spacious bedroom to the right and a bathroom adjacent to it. There is a large common area that separates my room from two other rooms that sit empty. At the bottom of the steps is a gated common area that links to the rear of the kitchen, and houses Baguira. Her area is the link to the kitchenette on the opposite end which is also gated to prevent Baguira from having full run of the house and atria. Everything is perfectly simple and functional, and the family is considered middle class. However, much to my horror and disbelief, they have no AC! I am melting just writing about it! I have been in sweltering heat my entire stay so far, requiring that I shower at least twice a day because of the epic amounts of sweating I do on a daily basis. Later, Mama Luz took me on a little trip to Playa Bacocho (Bacocho Beach) to see hatchling turtles make it from their release buckets into the Pacific. The process was interesting to watch as the hatchlings are a protected species and are collected during the day to prevent them from succumbing to predators. At early evening, they are released from the safety of the buckets into the oceans. It is a human-turtle friendly process that is monitored by a government employee or veterinary students. Once the turtles are released, their instincts kick in and they enthusiastically crawl towards the Pacific Ocean as the evening waves crash into the beach. The further up the water flows onto the beach, the easier it is for the baby turtles to catch a wave and ride it into the ocean, the point being, to make it into the water before a hungry land predator takes advantage of their vulnerable state. Except there was this one little guy who had a hard time figuring out which way to go. He was crawling at an angle to the waves, so while he would catch water, he was never positioned well enough to ride the receding wave into the ocean. Bless his little hatchling heart, it seemed he could not make heads nor tails of this particular goal. He reminded me of an article I read about bats whose ability to echolocate was gone, and whether they crashed into things when flying at night looking for a meal. Or maybe, the hatchling was like Jonathon Livingston Seagull? But I digress. The little turtle tried and tried to get caught up in a wave, but he just could not seem to do it. He almost made it several times to the applause of us all. But at the last minute it seemed as though he couldn’t get his little flippers worked out and always ended up on the beach at the last minute. At one point, a couple took pity on him and crossed the beach’s threshold. They used a piece of cardboard to turn him perpendicular to the oncoming wave so that he could get washed into the ocean. But try though that little guy might, he always managed to end up on the wet sand. He must have tried about 20 times before he seemingly said, “Eff it! I am going to take my chances with these two-legged turtles who tried to help me!” I kid you not, he just started walking towards the humans like, if he did not belong to the ocean, perhaps he belonged on dry earth. And the kind humans would take him back to the ocean’s edge and release him again. This went on until it was almost dark and then finally a strong wave came in and the water gathered around him from behind and washed him out to sea. We clapped for him and laughed with each other and retreated to our respective cars. Mama Luz and I walked silently back to the car and drove home, feeling almost reverent at what we just witnessed. Oh, and earlier in the day, we went food shopping at the open market in town, and I tried Chapulines for the first time…Go look it up…I’ll wait. The following morning, it was time to learn about the transit system in Puerto. The directions I got previously was to wait for a “collectivo” which would take me to my work assignment in Colotepec, a rural community with one small health center. However, because my hosts are lovely people, Papa Juan drove me, Linnett and Kennith into town. Linnett and I got out of the car and walked to our pick-up places and Papa Juan took Kennith to school. Little did I know that the collectivos were very much like buses. They picked up anyone who indicated they were going in the same direction; however, the car size is along the lines of a Nissan Versa and seats four people comfortably, one of them being the driver. The cost of our trip was 20 pesos, however, by the time we reached “la Clinica Salud” in Colotepec, there were six passengers in the car. No lie. Six! We learned quickly that the collectivo doesn’t stop because one is waiting for it. My student partner had to yell at the collectivo marked COLO on the windshield and they suddenly stopped in traffic, as we ran across said traffic to hop in the car. Another day, we missed the collectivo, so we had to await the next one, as they come every few minutes. It turns out, that there are pickup trucks with the rear encased in a metal skeleton and is draped with a tarp. The seats looked handmade but did not provide enough butt room to be seated comfortably. And again, no seatbelts or anything protective of passengers. My partner said, “I don’t know, Marie, this looks a little sketchy. I just laughed and climbed in because…because in for a penny, in for a pound. Oh! And traffic laws? Can we talk about that? So, as it turns out, the system of traffic lights exists primarily on the main thoroughfares, in this case Rt. 200, of Puerto. Once we turn from the main road into town, we were pretty much on our own as it pertains to driving. For instance, in my adopted neighborhood, one does not generally stop unless there is a stop sign. Except, THERE! ARE! NO! STOP! SIGNS! Which means that if driving, you just slow down at the intersections and decide if you can make it across before the oncoming vehicle becomes a danger to your safety, life, or limb. During the morning rush, while waiting for the collectivo in town, the streets are like typical rush hour traffic, except no one stops at the busy intersections. Everyone just slows down and if one happens to be among the group with the most traffic, everyone else stops. It seems that if in Puerto long enough, one develops the superhero ability of anticipating when to stop or go. All joking aside, the other thing I noticed was that many people use mopeds or “crotch rockets” to get around, and frequently there are two or three people on them. However, it seems there are no helmet laws nor laws regarding safety for children. For example, I saw a woman on a moped pause at an intersection, and her child passenger is slumped over the gas tank, legs dangling freely, still asleep. I also saw a couple and their infant riding a crotch rocket; the woman was seated behind the man and the woman was holding the baby to the side so that the baby was facing the sidewalks. Seeing those images, really made me think about my new home. Generally, people do what they must do to survive, and Puerto is no different. The lack of safe travels, car seats, helmets and whatnot are a function of the marginalization of poor people and nothing else. Both parents must work to support the family and they share the moped because they have an unforgiving work schedule that keeps them from being able to catch the collectivos. The fact that helmets are often not used is a function of poverty, not irreverence, much like the lack of car seats or safe riding situations for infants and children. My first day at the Clinica Salud, I participated in a seminar for women regarding an upcoming inspection by a health organization. After an ice breaker, the women were handed a questionnaire to fill out. However, many of the women don’t know how to read so one of the midwives would read the directions out loud to her group and they ladies would answer. After that was done, three separate people spoke to the ladies about the importance of keeping things clean and making sure the trash does not build up. One of the women said that the trash truck doesn’t always make it out to her community, so the trash would end up being ripped through by dogs and other animals. The solution was to notify trash pickup that the community needs to have trash hauled. It didn’t necessarily alleviate the situation because every day since, I pass trash bags in various locations awaiting pickup. Riding the collectivo home, I relaxed and marveled at the sheer beauty of Colotepec. The Sierra del Sud mountain range is the backdrop of the clinic on the ride away and I thought about the communities hidden in the forestry who have likely never received health care in the way the US is accustomed to. For instance, the examination rooms have a desk and an examination table. That’s pretty much it…Oh, and tongue depressors. There were no paper rolls attached to the edge of the exam table. Just a folded sheet. There were no otoscopes (used to look into ears), no computers, no gloves, no AEDs, no stirrups and no sinks! Rather, the doctor had to use her cell phone light to examine the throat; she made file notes using a typewriter, and she had to hand write prescriptions. The really amazing thing is that the doctors make the situation work, regardless of the encumbrances. For instance, a teacher brought in a child complaining of nausea, a fever, and abdominal pain. The doctor pressed and prodded, getting a small wince when she palpated the right side of his abdomen. Then she used a tongue depressor to look at his throat; which was a little red but nothing more. However, because of the fever and nausea, and she also hit the bottom of his feet, which I recognized as her attempt to discern whether he was brewing appendicitis. She had no access to abdominal CTs and had to rely on her physical exam to narrow down his illness. Because he was mildly uncomfortable, she also sent him to the in-house lab for a finger prick because Dengue is extremely common in this part of Mexico. After Dengue was eliminated, she instructed the teacher to speak with his mother when she came to pick him up about watching out for an exacerbation of his symptoms, especially if his fever spiked or he began to vomit. I have much more to write about, but I will stop here in the interest of time management. Stay tuned for more excitement as I learn to navigate my life without the niceties that come with living in the states. So, the last post I made was with respect to my first day working at La Centre de Salud in Ste. Maria, Colotepec. I was musing about my time there and taking in all the beautiful scenery. But that isn’t a fair description of my days… So, after arriving back in El Centre in Puerto I decided that I was going to walk the rest of the way home. Now mind you, the temperature was probably in the low 90s with a 99° heat index by the time I returned and made that insane decision. Perhaps I was already electrolyte deprived because it seemed like a good idea at the time. However, I had my water and Gatorade and felt completely confident and safe on my journey. The problem was, I thought I knew my way home by foot, and nothing could be further from the truth. First, my sense of direction was slightly off. I was doing fine until I turned too early down a side street and was suddenly fighting with sand. It was the epitome of a trap and I panicked a little (I peed a little when I panicked.) And every attempt I made to get onto solid ground was the exact wrong thing to do, but eventually, I got away from it. At one point, I ended up in a cul-de-sac with very attractive stucco homes. I checked my GPS for the 10,587-1/2 time and for the 10,587-1/2 it told me it was offline, and that I was one block away from where I needed to be. Eventually, I had finished my Gatorade and my water, so I sat down on a curb, completely exhausted. I still had the presence of mind to text Linnett and tell her where I was. Unfortunately, she couldn’t help me because she was still on campus (I probably did not mention she teaches at a college while working on her Masters.) By that time, I was feeling nauseated, I had a pounding headache, I missed lunch and I had to pee. And I sat in the sun and texted Linnett that I didn’t think I could make the walk home because I was simply too tired. As I continued to sit on the street, whose sign said the name was Mixtepec, I pondered what I was sure my final days. I was going to die in Mexico, on a side street whose name I could not pronounce, of heat exhaustion. Or heat stroke perhaps, I thought randomly; not that the method really mattered. I thought of the poor medic or policeman who would find my plumpness on the corner of Mixtepec and Montealban, puzzled as to why I stopped at that point to sit down and die on a hot curb with an empty bottle of water and an empty bottle of Gatorade. Surely, the medics (or coroner) who would be tasked with getting me onto the gurney would be the one(s) who ended up drawing the short straw. And I would be too dead to apologize for him/her/them for putting them in that position, because I know what it feels like to lift dead weight. (<<<I did not mean for that pun to happen, yet, there it is.) I decided to close my eyes for a minute just to rest them from the glare of the sun and cleanse them from the hot salty sweat that kept dripping into them. When I closed my eyes, I mused about why my lids were always red from my perspective. I am really not sure how long I was sitting there, but in my reverie, I noticed a dark shadow that kept crossing in my field of vision, such that it was on the inside of my lids. I am nothing if not curious, so I opened my eyes and could not figure out what was causing my eyelids from going dark. Something told me to look up in the sky and I found the source of the darkness. There were two large vultures circling over me! We-hel-hell! I decided that I was not going out like that and managed to force myself to my feet. I mean, in retrospect I’ll admit it was my vanity that forced me to get up, because perhaps the one thing that trumped medics choosing straws to see who would have to get me onto the gurney, was the thought of medics choosing straws as to who would distract the vultures while the others got my half eaten corpse onto a gurney and into a truck before they noticed that their lunch was being pilfered. The scene in my head was like something I saw when I lived in Carbondale, IL one summer. I was driving home from the local Wal-Mart and turned onto a main thoroughfare. I had to step hard on my brakes because in the middle of the road was a small dear that had died from something or another. But the two rather large vultures are what I see in my dreams to this very day. They looked at me, then looked at each other, and then cooperated to move the carcass out of the street so that their dinner was not constantly interrupted by us pesky humans. Kid. You. Not. But I have digressed again. Apologies. So, up I stand on the corner of Montealban and Mixtepec and, much to my vulture’s dismay, I began to walk again, down Montealban. And one block later and a left turn, there sat my new home! I let myself in, greeted Mama Luz, ate a light lunch and went to take a shower and a short nap. During my nap, I suppose Linnett called Mama Luz, my immersion coordinator, the director, and my travel companion, Sarah – or may there was a telephone tree. I don’t know. But when I tell you that I received no fewer than five text messages or calls, apologizing to me! I mean, I’ll accept those apologies if that’s what would help them sleep at night, but yeah…none needed, because that experience was all about me and my bravado. The following day went well, but rather than test my wits against the hot sun, I hailed a taxi to take me home. And I made it there a whole two hours earlier than the day before! The next afternoon, after a good day in Colotepec, I decided that I would walk to my Spanish class, which is about 20 minutes away from home. It was however, hot, but I was prepared this time. I had my water, another Gatorade and a much shorter walk with which I was infinitely surer of. As I walked, I noticed one of a thousand dogs in the area that roam freely. They are not a threat to anyone as it appears, they are cared for by everyone. There is an organization in Puerto that sterilizes dogs and cats, for free or at a reduced cost, and local people can foster or adopt. It is, perhaps predictably named, Perros en Puerto (PEP - Dogs in Puerto), and I think the organization has a catch, sterilize release program – or perhaps another organization does. PEP seeks to help dogs and cats find their “forever home,” but they also feed and water the dogs that are housed there. Back to my adventure. So, I notice the dog sleeping in front of a nice home with a gate entrance. I, naturally, assumed that the dog was sleeping in front of its home. However, while have that thought, I notice an additional shadow next to mine, and lo and behold, el perro was walking next to me. It might help to put this scene into perspective for those who do not know me very well…In certain circles, I am known as the “Animal Whisperer,” because I have compassion for just about any animal in distress, even the upright, two-legged kind. So, naturally, I greeted the dog with a “Hola, perrito, cómo estás?” Which he interpreted as an invitation to guide my steps. Now, I grant you that it was extremely hot that day, because that’s what happens around 3pm every day. But I really did have water and Gatorade. I mean, yes, I was sweating profusely, but I was fine. Fiiiinnnne! Now be patient with me here, as I explore the possibilities of the next events. Anyway, the dog literally pushed himself against my locomotion as if to tell me to get closer to the buildings, as I was walking in the street. There were no cars in the street, only me, the dog and the sun, beating down mercilessly. I stopped and took a sip of water and began to walk again, and again, the dog pushed me towards the buildings. It was at this point that I mused that maybe he was trying to help me, and that I must’ve been unaware that I needed help! I know what you are about to say, but bear with me, because, see…There was a news article recently, about a woman who was snorkeling when a whale swam up to her. It scared her, understandably, but it was very gentle with her. It put her under a fin, rolled her, put its eye up to her face and started to push her from the direction she was going. It took some time, but she realized that there was a tiger shark in the area, which are known to be one of the most aggressive shark-to-human sharks there are, second only to the Great White. Whales are also known for their altruism, sometimes helping seals to escape detection from Killer Whales, or outright challenging Killer Whales intent on eating a seal that it has cornered. So, maybe the dog was being altruistic towards me because it could detect I was in some sort of distress, like the lady on YouTube, and that only he was knowledgeable about it. This was the only reason that I could fathom that a dog would force me to walk alongside a building in the shade! I mean, it did not know me, and I certainly did not know it, yet it kept me from walking in the sun, until I got to the Oasis – the surfer building in which my classes are held. So, this final adventure is one I hesitate to share only because the incident was so very…shall I say, private. Apparently…there was this guy named Emperor Monteczuma II. He was the Aztec emperor that initially faced off with Hernán Cortés, a Spanish Conquistador. If you, dear reader, remember your European history, you will recall the Aztecs were nearly wiped out by European small pox which made it extremely easy for Cortés to conquer the Aztecs with only 500 men. I am not sure, but I do not think it happenstance that Cortés was from Medellín, Spain. Ok, back to my tale of woe. So, the story says, that prior to his death Monteczuma put a curse on the Europeans, and whenever they travel to Mexico, the curse culminates in…shall we say…the trots. The runs. Or more politely (? Is there such a thing when this happens?), Traveler’s Diarrhea. Now, let me share with you why I balk at the nomenclature regarding this most egregious event. Firstly, the emperor’s curse was on the Europeans, the Spanish to be exact. I am neither of those. Second, traveling to Mexico was a lot like me returning home. I recognize Mí Gente (my people), even though distantly so. And finally, Monteczuma II knew I would’ve been riding shot-gun for had I been alive then! Anyhow, early Friday morning, let’s say 3-4a.m., I was awakened by my stomach. It was not an urgent awakening, but it got my attention. So, I got up and went to the restroom (this might be a good time to tell you that toilet seats are apparently for only the wealthy). A little muss, but no fuss. I went directly back to sleep. My alarm went off at 6:30 a.m. as usual, and I put the snooze on. At 6:45 I got up, took my shower, and went down for breakfast, which was my usual coffee and toast (this might also be a good time to tell you that coffee stimulates the bowels, something I have known for some time). I don’t think I was two steps onto the sidewalk to catch the collectivo when something happened, that can only be described as betrayal by my body and my distant ancestor, Emp. Monteczuma Xocoyotzin. Now, I ask for your indulgence and forgiveness when I tell you that I was given exactly ZERO warning about what was about to happen; nor was I given control and I do not exaggerate. When the first wave hit me, I turned right around and went back through the door and began swiftly walking back to my room. But my pace mattered not, because with every step I attempted I lost control over, ahem, other parts of my anatomy. Eventually, I no longer cared, and I sprinted up the steps to my bathroom. By the time I disrobed and sat, my clothes were ruined, the floor was ruined, the steps were ruined, and I am sad to say, I was ruined. Utterly and most completely. I sat there, and things just fell out of my body with no concern for my emotional welfare. I could not even take a breath in any attempt to reduce the flow, because such attempts were met with cosmological laughter, that I recognized as my ancestor, the Noble and Kingly, Emp. Monteczuma Xocoyotzin. The aftermath of that was somewhat more kind to me, as I had an antibiotic prescription at the ready before I left Ohio. I also packed Imodium, which was also invaluable. I had only some mild nausea, and my program coordinator was kind enough to bring me some liquid electrolytes, which I found out later, is one of the best sellers at drug and grocery stores. But the story here is not how kind everyone was to me as I lay in bed, afraid to move for fear of more vengefulness despite having taken my medications. No…The real story here is that on that day, the most Emp. Monteczuma Xocoyotzin, made me his one and true bi-atch! Ok, that was the end of my first week, like, for realz. I will stop here as I need to begin adding the pictures, I took to give you the birds eye view, so you have a better frame of reference, Dear Reader. I know, I know, I said that before, but THIS time, I am for realz! Adiós! So last time, I left you with a loving tale of my on-again-off-again lovefest with the Most Honorable, and Deserving, Emp. Monteczuma Xocoyotzin. Clearly, I survived our little tryst, but not for lack of his efforts. I decided to combine weeks two and three herein because there is an overall theme that is present in both locations in which I worked. Hence, today’s post will take on a more serious tone because of the subject matter. As you know by now, I spent two weeks at the clinic in Colotepec. It is more a community clinic than anything, however the focus is usually on the women and their infants. There are a couple of things I found interesting while serving there. Many of the women were young, some barely out of their preteens. However, there is never any shame, covering up for, nor hesitation to breast feed their children when they are hungry. None. Crying baby? Great! Expose breast. Feed. For me, at least, that was quite remarkable. Coming from a society that frowns on the baring of breasts while feeding children but has no problem with women walking around on beaches in the summer with bikinis that have triangles to barely cover the areolas and one to cover the pubis, and then a string in their butts and to their backside, provides me with a little cognitive dissonance. I have seen women be admonished by people they don’t know for feeding their infants. I have seen women lambasted for not “covering” themselves up while trying to feed their children in peace. Mexico – on average – has 90° days with +100° heat indices. There is no instance in which a woman should be expected to place a cover over most of her body to feed her infant(s). And I think that more women in the US should challenge the sexualization of the breast by feeding their infants in public, because the only way to remove the stigma is to normalize the behavior. Negative commentary, disparaging/sexualized remarks, suggesting that an infant should not be fed when he/she is hungry is harassment and should not be tolerated. And that is too bad when one considers that breastmilk aids in so many neurological milestones, as well as builds antibodies, because what those naysayers are suggesting is quite a bit like encouraging mothers to neglect the needs of their children’. And your feelings about breastfeeding in public should not be a factor when a mother needs to feed her child. None. Of the many patients that we saw, most were women and children. For instance, one day a mother came in to speak with la Dra. About getting contraception for her daughter, who was but 14 years old. The mother stated, that she wanted to give her daughter the chance at getting an education and having a better life. La Dra. Spoke with the woman and told her that if her daughter came in and asked for birth control herself, then she would provide the daughter with her options and allow her to choose. The following day, a sad and withdrawn 14-year-old girl came into the office during her school lunch break and shyly asked la Dra. for contraceptive services. La Dra. began to ask her about her sexual history and the girl completely shut down. She could not look La Dra. directly in the eye and held her head down and slightly to her left so that at least one eye met her patient gaze. La Dra. Continued with her line of questioning and asked the girl how many times a week she was having sex? “Two.” “Are you able to bring up the subject of condom use with your partner?” Silence. “It says here that you had a baby last month. Is that true?” “Si.” “Do you have help with your baby?” “Si.” “Does the father help you with your baby/” Silence. “Does the father help you with your baby?” Silence. “Were you sexually assaulted? Raped?” Silence. Though her eyes betrayed her reality with tears, as she attempted to cool her visceral response to the question. Which worked, as evidenced by the fact that those tears never made it out of her eyes. Finally recognizing the source of the grief and sadness, La Dra. asked the girl if she wanted to be examined and tested for STIs. The girl shook her head no. La Dra. Asked her young patient if she wanted to report the rape, and the girl shook her head no, as she was no longer able to hold her head up. La Dra. Asked the child if she knew what type of contraceptive she wanted, and she indicated that she wanted to get the monthly shot or the arm implant. La Dra. explained the risks and benefits between the two options and the girl chose the implant. La Dra. enthusiastically endorsed the child’s choice and made the arrangements. She also prescribed the child a broad-spectrum antibiotic on the chance she has been exposed to an STI, as Chlamydia is extremely common in the population, but more so in young women of reproductive age. After the child left the office, I expressed my moral outrage and heartbrokenness at what this child has had to endure in the last year. We all zeroed in on the possibility that the offender was a family member, and that her desire not to file the report was due to a warped sense (to us of course, because our sensibilities were informed by our “progressive” experiences) of familial responsibility. One thing I wanted to clear up, just in case I left you with any stereotypical notions through my humor. There are speed limit signs posted. But I realized that it is no accident that the speedometers in most of the cars in which I have ridden are broken. The last working one I saw was last week and the car was new. So if you don’t know what to look for, you could miss a posted speed limit sign (like I did). There are two different speed limits that most drivers adhere to. Stop, and Faster. The reason should be clear to you based on some of my other descriptions. A driver benefits more if he can increase the number of fares he would get if he obeyed the speed limits. Needing to do that is another one of those things that are not necessarily the fault of the drivers. They “steal” fares from their fellow drivers because they do not get paid a living wage and nine times out of ten, they have a family and/or extended family for whom they are responsible. Even by our minimum wage standards, the drivers do not earn a living wage. Everyone here, everyone, regardless of age or socio-economic strata, works extremely hard. I have seen little gray-haired ladies climb up in the back of those retro-fitted pickup trucks with two buckets full of whatever and claim their seat amongst the rest of us workers. I have seen young ladies, no more than 16 or 17, with two or three children trying to get to the children’s schools so that she can go to work, because at this point in her life, school is done for her. The fact that she had to quit school is a difficulty as well because she cannot hope to earn the money to support her family without a more advanced education, yet she cannot get a more advanced education if she cannot make informed decisions regarding her reproductive health. Culturally, there are some fundamental problems surrounding the issue of women’s reproductive health. In many areas, not just Puerto Escondido, there are communities descended from Aztec and other indigenous peoples. As it currently stands, there are at least 37 indigenous languages spoken and these communities often have their own codes of conduct. One of the main issues in almost every community throughout the world is that there is often an unspoken rule regarding sex and sexuality and whether women have choices about what happens to their bodies. It has been a difficult realization that the girls and women have nearly zero agency when it comes to deciding when and with whom they have sex. While marriage is encouraged at certain ages, many young people here remain ignorant about the fact that sex often makes babies, what sex is or isn’t, what STI’s are, how to avoid these myriad situations. Sometimes very driven by hormones girls as young as 11 have gotten pregnant without having had their first menses, if they even know what a menstrual cycle is and what its presence, or absence, means. Having access to necessary feminine hygiene products and starting one’s period is often the end of one’s daily education because young girls cannot attend classes when they are menstruating. Further complicating the life of a teenager, is the notion that her body is not her own. Once a teenager begins to have secondary sex characteristics, avoiding pregnancy is nearly impossible. And as young women are made aware of their options, two or three different social attitudes emerge. First, there is the problem of negotiating (or not) sexual activities that include using condoms and/or oral contraception. There is a large amount of misinformation about what contraceptives do to one’s body. The beliefs range from using contraception will make the women have more sex with different people, to the age-old complaint of “it” feeling different or less pleasurable for the male partner if condoms are used. When young women do get pregnant in their teens and younger, their pregnancy is automatically considered high risk because their bodies are still growing and changing and her, often too small, pelvis is not large enough to house a growing baby. Often when complications arise, and they do so more frequently in teens, there may be a reluctance to seek out help in the local ER. This is because either, the father objects to his spouse being removed from the home, especially if there are other children who need care; or a reluctance by pregnant women to go to the hospital because they are afraid the doctor will do something to make them sterile. If they cannot read or speak Spanish, any amount of encouragement to go to the ER may fall on deaf ears because, like many women in Mexico they believe in their Doula’s abilities well past agreeing to any outside help. The second issue that often prevails is the notion of the doctor/patient relationship as sacrosanct. When women decide they want to use contraception, they will do so without their sex partners’ knowledge. This is necessary because using contraception is thought to be an attack on men’s virility. And, in order to protect their privacy, some women will often opt for the Norplant, or a monthly shot. Being able to make an informed decision about birth control means births among young girls will begin to fall. In conjunction with that, women can avoid the physical burden of getting pregnant immediately after the previous infant, giving her body a chance to completely heal before becoming pregnant again. Further, not having more babies means girls and young teens have a chance to complete their primary and secondary educations, which logically increases their earning potential over their life time, especially if she has an opportunity to get her formal education at the local Universidad. I think this is a good place to stop, especially since my third week of work was not as advertised. There are some great experiences I want to share with you from this week (#4), and I have not decided if it would be better to post as each day goes by, or to post once I have finished my immersion. I don’t know, Dear Reader. What do you think? So, I am quite tardy with this post, Dear Reader and I must beg your forgiveness, for I have been home for ten days and I have yet to complete the information necessary for you to see Puerto through my eyes. At the end of week 3, I met with Dra. Isabel, and she questioned me about my experiences at La Clinica Barra. “Bueno o Malo,” she asked? I tried to finesse it with my broken Spanish, but I think I may have done more harm than good. My third week experience was very disappointing because I thought I would, finally, be able to shadow a Partera and help indigenous pregnant women. Unfortunately, Dra. Antoinette, my preceptor for week three was mostly unavailable for a variety of reasons. Additionally, there were not very many patients and besides the patient base of mostly men and boys, a very few were women of childbearing age. The clinic itself was newly built – perhaps a few years ago – and it had many “perks” compared to the other clinics. For instance, in addition to consultation rooms, there was also a “Psychologia” room, from which patients could obtain emotional support for problems. There was also a pharmacy which housed the most common medications needed, like anti-biotics, prednisone, and anti-hypertensives. The really striking difference was what the staff had access to in Barra versus Colotepec. For instance, if you recall my earlier description of Colo, you will remember that the doctors there had access to tongue depressors and exam tables. Even though Colo had a pap and mammography push, when the women returned with their results on DVDs, there was no way for the Doctoras to pull up a scan as a frame of reference. The only thing the Doctoras could do was to read the diagnostic by the radiologists. Comparatively speaking, Barra not only had desk top computers, but they could input patient information instead of having to use a typewriter. Barra also had a bona fide delivery room as well as a recovery room that could house two women and their newborns. However, that is not the difference that really impressed me, thought the differences were stark. What really impressed me was that for one of the very few pregnant women that did have an appointment, Dra. Antoinette used a handheld ultrasound to locate and listen to the baby’s heartbeat. And the story became even more fantastic when she told me that they had FIVE units in-house! The reason I found that so remarkable was because the clinic in Colo has exactly ZERO, and the Barra location would probably never have more than one other doctor, which means that three would always go unused. While I did not say that to anyone, it is an observation that I intend to place in my final submission, because in an area where healthcare access was, at best tenuous, resources like handheld ultrasound units should not be sitting idle in one location while another location has no access to even the most basic resources. Additionally, the type of ultrasound machine would be a great asset for the Parteras to use as they made their rounds to the villages to see their patients. And teaching the Parteras to use them properly would probably not take more than an hour or so. It really was frustrating that I did not have an opportunity to shadow any of the Parteras while I was in Barra. By the end of the week, I had already decided that I was going to ask for a different assignment location because there was literally nothing for me to observe. So, when Dra. Isabela asked me if La Clinica Barra was “bueno o malo,” my attempt to finesse my experience was unnecessary, because Dra. Isabel already knew. And when we met for our weekly meeting at the end of week three, I didn’t have to say anything, because la Dra, had already had me reassigned to a different clinic. A busier clinic, I was soon to discover. But I so appreciated her intuitive nature regarding my experiences. It was plain that it was important to Drs. Isabela that I have a positive experience, and she made certain to facilitate that. On Monday morning of week four, Dra. Isabel came by the house to pick me up and take me to La Clinica Zicatela. Zicatela was closer to the center of town and only cost me ten pesos a day, provided I caught the appropriate collectivo. When we arrived, I introduced myself and was quickly ushered into the examination room of Dr. Andres. Dr. Andres motioned me to sit, because he was still collecting information from the patient whose intake I had just interrupted. After he finished, I introduced myself in Spanish and he immediately started to talk in that rapid-fire way and I was completely lost. It wasn’t that I did not understand what was being said, it was that my brain was not able to keep up. He did slow down at one point, but then my jitters at attempting to speak Spanish to someone fluent kicked in and I am sure I seemed like I was someone who did not care to learn the language before coming to visit. When I froze up like that, my eyes would wander trying to search for the words in my brain, and despite the reassurances of my family and my teacher, I was not able to shake that initial insecurity; which made me feel worse. As it turned out, Dr. Andres only had one or two more patients for the morning and let me go earlier than anticipated, and told me to come back the next day at 8:30 a.m. I was late the next morning because all the taxis that I would have taken to Zicatela were full of smarter people who caught the collectivo before it reached me. The ride was all of 3 minutes long and I hated letting go of that 30 pesos for the privilege of being late for 5 minutes verses being late for 6 minutes because the collectivo behind us was the one I was initially supposed to take, and the vehicle had exactly ZERO fares in it. I was SO aggravated by that! I felt like…like Captain Kirk in the Wrath of Khan movie. You know, the scene where Kirk shakes his fist menacingly in the air (Not really, but literary license maybe?) at the distant space ship Khan outwitted Kirk to get? Yeah, that one, with Kirk yelling, “KHHAAAAAANNNN!!!” That’s what I felt like. (Side bar): Early in my trip, I learned one of the best things about the population in Puerto. Everyone, and I mean everyone is so polite that when one walks into a room of people, one must greet those people. So, for the last three weeks, I had been saying “Buen dia,” to rooms of people who were unrelated to me, and every single one of them greeted me back. Anyway, I walked in to see Dr. Andres, but he was already in the middle of questioning a 45-year-old female whom the doctor had treated for TB. TUBERCULOSIS! Which he did not tell me about until the patient left. The doctor did a light physical exam which consisted of listening to her heart and lungs. He then invited me to listen. I had the heart exam done, and then thought I heard some “rubbing” in her right lung. I didn’t say anything and then when the patient left, I (stutteringly) said: ”Escuché un roce en su pulmón derecho. (I heard rubbing in her right lung.)” Dr. Andres nodded “si’,” and then asked me what I thought was wrong. Without knowing more, I told him I thought she might have had a bout of bronchitis or pneumonia. Dr. Andres shook his head no, and then got up to wash his hands, inviting me to follow suit when he finished. I did as commanded and when I sat down, Dr. Andres said, “Tuberculosis.” My eyes widened with, oh I don’t know…Shock? Fear? And then he said to me, though it took me a while to get the message, “Siempre, siempre lávese las manos entre los pacientes.” “Always, always wash your hands between patients.” (Side bar): That’s the other thing I liked about being in Puerto. Before my trip, I had been told that I can be very…Verbose. (Me?) And I have really tried to be more succinct. I realized, however, that my inability curb that habit directly interfered with my ability to speak Spanish well because I was wasting time thinking about the Spanish equivalent of “succinct.” In Spanish, one says what one means. Dr. Andres and I saw a total of nine patients that morning, all interesting, three of whom were from the target population I wanted to serve. The other patients, for instance, were comprised of two female patients with diabetes and hypertension. One was aged 25 and needed treatment for chlamydia, and the other was 51 and experiencing low back pain. I found the difference in age important because it demonstrates the burden of disease among certain populations regardless of age. We also had two older women (I learned not to use the term “vieja” to describe older women. It is better to use the words, “Ella tiene gran años.” – she has many years). One had hypertension and a red, swollen left knee, while the other had painful varicose veins. We also had three patients who were of child-bearing age. One patient had an 18-month-old toddler with dermatitis. One 16-year-old patient was 16 weeks pregnant, herself only weighing in at less than 100 lbs. The last patient we saw was 16, with a two-year-old son and she was seeking contraception. The note that I made to myself at that point was that she was pregnant at the age of 13, having had her baby at 14. This is a very common situation and again, falls along socioeconomic lines in terms of shouldering the burden of maternal and neonatal deaths among indigenous populations in Mexico. The following day, Dr. Andres and I only saw four patients. Our first patient was an 88-year-old-woman with diabetes. Her heart and lungs were clear, but she was complaining of pain in her left hand that ran up her arm to her neck. The doctor added Diclofenac to her list of diabetic medications, Metformin and Glyburide. We next saw a 50-year-old-woman who looked 25. She had four children and weighed in at 105 lbs. Unfortunately, she was one of the people who bore the burden of diabetes which undoubtedly caused the caused her right-side heart murmur. Later we saw a young woman who was 16 and pregnant and already had a child who was two. At the end of our morning we saw a woman, about 74 years old (she did not know her birth date), with a red and painful lower left leg, initially due to a falling injury that left a scab on her left knee. For this patient, Dr. Andres prescribed Diclofenac and an antibiotic because he was concerned about her ability to fight a possible infection. That Wednesday, Dr. Andres was not available, so I shadowed Dr. Elvis, a young man who looked younger than my children. He was very personable, and he told me that we could help each other because he was learning English! Dr. Elvis tried to accommodate my request to speak slower, but it quickly became apparent that he was as incapable of slowing the cadence of his speech as I was of looking up and to the left when trying to form a coherent sentence in Spanish. If I were to compare my observational experiences this day would probably rank at the top in terms of variety. I had already accepted that most of my last patient observations were not going to be women of child bearing age, so I (finally) decided that I would take a step back and simply enjoy the experience. Our first patient of the morning was a 76-year-old-woman with hypertension who needed a new prescription of Captopril for her 91-year-old-mother’s hypertension. The next patient was a 75 -year-old-woman with hand and foot pain. After examining the patient’s foot, Dr. Elvis prescribed Ibuprofen cautioning her to make sure she ate a good meal before taking the medication. Surprisingly (for me at least), the patient spoke very little Spanish because she had been living in Puerto for only three years. Her native tongue was “Chinantec,” one of the 37 or so indigenous languages spoken in Mexico, primarily by indigenous people living in Veracruz and northeastern Oaxaca. Increasingly, indigenous people are leaving their villages and moving to larger cities because gaining access to certain resources required that. I’m not sure how to feel about that, because it was obvious that staying in one’s birthplace meant that access to resources controlled by the government was limited. And this is true for most, if not all indigenous peoples in Mexico. This necessarily means that the indigenous populations were suffering from institutionalized racism, despite the government’s provision of, for example, text books in indigenous languages. But that provision assumes that there are schools in remote areas staffed by educators who are aware of the resource and understand how to gain access to them. The situation is similar about health care access. I observed at three different federally funded clinicas whose primary mission is to provide the health and health care services to indigenous populations. My observations were to be focused on women’s reproductive health, but every indigenous person I saw needed to have access to health care, and the presence of those clinics are the Mexican government’s outreach to traditionally marginalized indigenous groups. One of the (unintentional?) impacts that the outreach effort has is that of removing the indigenous people from their traditions and culture. The Parteras aside, that inherently means there will be an eventual loss of identity, traditions, and culture that can never be undone. So, on the one hand we have marginalized people who deserve a seat at the government’s economic table, but on the other hand, in order to get and maintain that seat, one must be willing to lose certain aspects of their culture. That conundrum is as old as colonialism and so far, reeks of racism and classism. But I do not know what the solution is. Next, we saw a 78-year-old-man who was a lifelong smoker. He was complaining of chest pain when he inhaled. Interestingly though, his heart and lungs sounded unremarkable. Dr. Elvis sent him for chest xrays anyway. One of my favorite patient interactions was with a 68-year-old-woman who weighed about 105 lbs. She had episodes of eye pain followed by dark or blurry vision. When Dr. Elvis began to ask her health and social history questions, the woman either nodded enthusiastically or repeated the question back to Dr. Elvis as a statement. Once Dr. Elvis realized what was happening, he stopped and simply asked her, “¿Hablás Español?” And, bless her heart, she said “Oh! No! Hablo español un pequeñito.” Dr. Elvis did not need to translate that for me because I felt her pain! I really wanted to tell her that the struggle was real, but I am sure she would not have understood the context of my comment. Dr. Elvis asked the patient what her native tongue was, and she said “Mixteco y Zapotec.” Dr. Elvis then left the room to see if he could find another patient who spoke either language but came back empty-handed. Instead, he motioned to the patient to sit on the exam table and as soon as she did, I saw the tell-tale signs of serious eye disease: the cloudy halo around the retinas. The doctor prescribed eye drops and asked the lady if her daughter (who spoke both Spanish and Mixteco) would take her to the hospital. The lady gave an enthusiastic sí, and then prepared to leave. As she gathered her belongings, I said in my broken Spanish, “¡Tu y yo somos familia, por que no entendémos el Doctor! (You and I are family because we do not understand the doctor!)” We all laughed, but I had no idea if she understood me or not. But then she shook the doctor’s hand and followed by mine. Then she surprised me and leaned in for a two-cheeked kiss and said, “Gracías.” Best patient ever! The patient after her had a sinus infection, and then we saw a 78-year-old-man with hearing loss, but who was able to read lips. Dr. Elvis started with the usual health and social history questions. Then he looked at me and smiled and then asked the patient how old he was when he lost his hearing? The patient stated he was about 58. Then the doctor asked what happened to cause his deafness and the patient said that he was struck by lightning! Dr. Elvis asked if I understood what the patient said, which I must admit the phrase “I was struck by lightning,” was not among my Spanish speaking repertoire. You know, like “¿Donde está la bibliotéca?” It just never came up in conversation. Once Dr. Elvis translated that part for me, our patient, who was only there for a new prescription for Captopril, became the most interesting patient in the world to me! I asked for permission to exam his ears, which he granted, and I used the otoscope to peer down his ear canals. (Side bar: In all the clinicas that I visited, there was a sore lack of “basic” supplies like otoscopes, much less the specula attachment needed to guide one’s view. Dr. Elvis had three specula that were cleaned with alcohol and re-used.) Now, I know there are those of you who love me despite my weird fascination with odd things the human body does like making mush-filled cysts on just about any part of the human body. But please bear with me…The left tympanic membrane was completely covered in scar tissue and the canal was completely clear of any earwax. I don’t know if that was functional due to the scarring or not, and I made a mental note to ask, but I forgot. The right tympanic membrane was also covered in scar tissue as well except for a small shimmery spot at the bottom left hand side, if you can imagine that. Anyway, I thanked the patient for allowing me to examine his ears and he waved me away like, “No problemo!” The last two patients of the day were interesting as well and both were women. The first lady was 68 and had diabetes and hypertension. The doctor rambled off his questions, but when she stated that she had ten children he stopped her to double check that number. Clearly, he saw something in her chart that made him repeat the question, but who knew it was the fact that she really had 12 children? She stated that her last two were “sopresas,” and that she sometimes forgets to include them because they came so late. Turns out, she had baby #11 when she was 53 and baby #12 when she was 55! That meant her youngest child was only 13 years old!! In her shoes, I can only imagine myself throwing another “Khan” fist shaking fit at the universe if this had been me. Our last patient of the day, Dear Reader, was one of the saddest situations I observed, because of the level of fear on our patient’s face as the doctor spoke with her. This patient was 28 years old and had a recent history of kidney infection that the doctor treated with antibiotics. Following treatment, the doctor sent her for follow-up blood work and urinalysis, and the news was not good. Her blood test results were irregular, and her urine was cloudy and contained red blood cells, proteins, (white blood cells) and pus. As soon as I looked at her results, I knew what he was telling her, and the look in her eyes was unmistakable. She was scared shitless, and all I wanted to do was to tell her everything would be alright. I desperately wanted to reassure her, but it would have been highly irresponsible and unethical for me to have done so. The doctor explained that he wanted her to get a family member to return to the hospital with her to get imaging with contrast. I saw the patient’s eyes fill with tears, and all I wanted to do was to hug her and encourage her to follow through with the doctor’s orders, but I just sat there trying to will calm in her so that she remained clear-headed throughout this ordeal because she had three children who needed her. Big Side Bar: I realize that my assessment regarding her children’s need of her presence is couched in my biases, both cultural and social, but in this case, I do not think that I am incorrect. In many cultures in Mexico, childcare and rearing is done by women. If the mother is unavailable, the father is not expected to provide day to day care for his children. That reality is one of the issues regarding the high death rate among indigenous women in Oaxaca following childbirth. When a pregnant mother has been told by her Partera that she needs to go to the hospital, there are many cultural realities that are in opposition of her healthcare needs. We discussed such cultural issues with Dra. Isabela during one of our weekly meetings, and the reality is that so many young girls and women die during or shortly after delivery because they, or their spouses, have refused hospital care after the Partera has evaluated the need of it. One of the primary causes of maternal deaths is infection of the episiotomy (whether surgical or torn) leading to sepsis. Once a mother has died, her newborn is at greater risk of neglect, abuse, and death. If there are any older children left behind, those children are at greater risk of neglect and abuse, because the expectation is that the older children care for their younger siblings, to the exclusion of everything else. This situation is often magnified if there are no extended family-members to help. This is a very difficult situation because the way out of the conditions in which the children may currently live is education. But if they stay home, they cannot continue their studies. This is another one of those burdens discussed earlier that are borne by indigenous populations, piled on top of the premature deaths of mothers. Another barrier to emergency or hospital care following childbirth are societal ills. If fathers do not object to the mother going to the hospital, the mother may still object to going. Among many people, there is a belief (that is probably grounded in truth), that going to the hospital opens one up to sterilization without consent, or other procedures not fully understood. It is an unfortunate reality that marginalization opens communities up to abuses by those in government, education, and medicin

I attended CFHI's two week intensive Tropical Medicine and Community Health program in Puerto Escondido. CFHI programs appealed to me because they are not for profit and based in partnership and exchange. Their motto, “Let the world change you,” is real and something that all of us in dominant cultures should do more. Being in Puerto with CFHI was a transformative experience. It was helped me to expand my view of community and global health, and see the ways in which our actions in the United States and modern medicine affect the rest of the world. I was welcomed into the clinical settings and appreciated the ethical approach of CFHI surrounding international experiences in healthcare. Volunteering to "fix" problems in other countries from an ethnocentric position doesn't usually create sustainable change - and often is damaging to communities. I really appreciated how the medical director in Puerto was a public health doctor in the community. Our (excellent) language classes and homestay were through another local business - and very professional. My whole experience in Puerto felt like real service learning, and was built upon long-term sustainable relationships. My time in Oaxaca was illuminating in that I could see how all different kinds of medicine can coexist. And I also found people that I could relate to, especially in terms of the paradigm shift we want to create. It’s not always easy to merge the old with the new. We need evidence-based practices in healthcare, but we also need the wisdom and knowledge of our ancestors – and we are losing this with each passing generation. We need to reconnect the mind and spirit to the body when we’re working with patients and we desperately need all forms of healing on all levels – from individual to community to global.